G28(P) Wipe and wait: improving skin cleansing and line access technique to reduce serious blood stream infections in a neonatal intensive care setting

Background Central lines are a vital component of ongoing care in the neonatal intensive care unit (NICU). Central line associated bloodstream infection (CLABSI) is a leading source of sepsis in the NICU setting, with up to 20% mortality. Aim We aimed to achieve significant reduction in the number of positive blood culture and CLABSI events in a tertiary NICU setting by implementation of an education strategy to teach correct skin cleansing and line access technique for 100% of patient encounters. Method Positive blood culture and CLABSI events were recorded at baseline and monthly throughout the study period. We established optimal cleansing technique using chlorhexidine gluconate 2% solution allowed to dry for 30 s prior to any skin break or line access procedure in the NICU. An audit to establish baseline compliance was performed. Subsequently, an educational bundle was introduced for all NICU staff involving face-to-face teaching on the importance of the technique, placement of reminder posters with the slogan ‘Wipe and Wait’ in key clinical areas and audits of compliance were commenced. Results At baseline correct cleansing procedure was recorded as 100% for central line access/insertion events but 0% for peripheral line access or skin break events. Data recorded 6 months prior to introduction of the educational bundle showed positive blood culture and CLASBI rates ranging from 6–14/month and 2–4/month respectively. Data for 3 months post introduction of the education bundle showed a decrease in blood culture and CLABSI rates ranging from 0–3/month (difference in medians, p=0.03) and 0–2/month (difference in medians, p=0.06) respectively. Conclusion We demonstrated that good cleansing for peripheral line access/skin break events as well as central line access events resulted in a rapid and significant reduction in positive blood culture rates and reduced CLABSI rates within our NICU setting. This work highlights the importance of correct cleansing technique in performing all procedures within the NICU. It also demonstrates the substantial benefit of this simple educative intervention in improving quality of patient care and reducing infection in NICU patients.